Should an Anti-incontinence Procedure Be Routinely ...

Curr Urol Rep (2010) 11:304¨C309

DOI 10.1007/s11934-010-0123-7

Should an Anti-incontinence Procedure Be Routinely

Performed at the Time of Pelvic Organ Prolapse Repair?

An Evidence-based Review

Humphrey O. Atiemo

Published online: 19 June 2010

# Springer Science+Business Media, LLC 2010

Abstract The concept of prophylactic anti-incontinence

surgery for women undergoing prolapse repair has been a

popular and controversial debate in recent years. This

article provides an evidence-based review of the current

literature to determine the proper evaluation of the patient

with prolapse, the predictive quality of preoperative

urodynamics, and the selection of the appropriate antiincontinence procedure. Based on this review, the midurethral sling predominates as the procedure of choice;

however, there is poor evidence to suggest that routine

usage of a prophylactic sling is warranted in treatment of

the patient with pelvic organ prolapse.

Keywords Pelvic organ prolapse . Burch colposuspension .

Midurethral sling . Urinary incontinence . Urodynamics .

Pubovaginal sling

Clinical Trial Acronyms

CARE Colpopexy and Urinary Reduction Efforts

OPUS

Outcomes Following Vaginal Prolapse Repair

and Midurethral Sling

SISTEr Stress Incontinence Surgical Treatment Efficacy

Introduction

Pelvic organ prolapse (POP) and urinary incontinence are

significant disease processes that affect women particularly

within the 5th to 6th decades of life. The risk of surgery for

H. O. Atiemo (*)

Department of Urology, University of Michigan,

3875 Taubman Center, 1500 East Medical Center Drive,

Ann Arbor, MI 48109-5330, USA

e-mail: hatiemo@umich.edu

POP or urinary incontinence by age 80 is approximately

11.1%. Surgical intervention for POP with (22%) or

without (41%) continence surgery was the attributed cause

for 63% of this risk. This represents a lifetime risk of 7%

[1]. The concept of anti-incontinence surgery at the time of

POP repair has been a popular topic in recent years. Maybe

the most prominent paper that brought this concept into the

forefront was the CARE trial published in 2006 [2].

Members of the Pelvic Floor Disorders Network sought to

determine if a standardized Burch colposuspension at the

time of an abdominosacrocolpopexy (ASC) would reduce

postoperative stress urinary incontinence (SUI) in patients

without preoperative symptoms of SUI. The results were

that women who did not receive the Burch procedure were

more likely to report bothersome symptoms of stress

incontinence than those in the Burch group (24.5% vs

6.1%; P ................
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